Saturday, July 12, 2014

THE SIDES OF THE TONGUE


As the previous blog on the chest/breast area of the tongue has aroused some questions about the sides of the tongue, I would like to clarify some diagnostic aspects of the sides of the tongue.

Of course the sides of the tongue reflect the state of the Liver but there are circumstances when they reflect the state of the Spleen.

The area on the sides reflecting the Liver is long and rather narrow.  By “long” I mean that it extends almost from the root to near the tip.  A redness of this area is very common and it indicates Liver-Heat.

Liver areas













Red sides, Liver area












Swollen sides, Liver area














The area on the sides reflecting the Spleen differs from that reflecting the Liver in two ways:
1) it is less long, being concentrated in the middle section of the tongue (Middle Burner);
2) it is wider.

A common change in this area is a swelling which indicates Dampness in the Spleen.  It also is often pale, indicating Spleen deficiency.  If it is pale and swollen it indicates Spleen-Qi deficiency leading to Dampness.  The Spleen area may also be red indicating Spleen-Heat.

Spleen areas



















Spleen areas














Swelling Spleen areas













Redness Spleen areas

Compare this redness on the sides with the redness in the Liver areas above (first picture)










The chest/breast/ area is completely different being confined to a relatively small area between the middle section of the tongue and the tip.

Chest/breast areas


Wednesday, July 9, 2014

CHEST/BREAST AREA OF THE TONGUE

The “chest/breast” area is on the sides of the tongue, between the centre part and the tip.




The chest area reflects a pathology of three organs: heart or lungs in men and women or breast in women.

The chest area reflects pathologies of the lungs, heart or breast but in a Western medical sense.  A change in the chest area may involve a change in colour or body shape.  In women, how to differentiate when a change in the chest area indicates a problem of the lungs or heart or of the breasts?  In women, a change in the chest area indicates a pathology of the breast rather that of lungs/heart when two conditions are fulfilled:

1) In the absence of an obvious lungs/heart pathology
2) Especially when it is unilateral

Thus:
Men: lung, heart
Women: lung, heart, breast

Examples of lung pathology manifesting in the chest area are chronic asthma or chronic emphysema (in which case the chest area would be swollen and possibly purple). An example of heart pathology is chronic coronary heart disease (in which case the chest area would be purple).

As the area on the sides between the centre and the tip reflects the condition of heart/ lungs/ breast, I call this the “chest area”.

Changes in this area to look for are:
1) Changes in colour (usually purple or red)
2) Changes in body shape (usually swollen or with teeth marks)
3) Red points
4) Lack of coating

In women, a purple colour in the breast area indicates Blood stasis in the breast.  Blood stasis in the breast may cause masses such as fibroadenoma or carcinoma.




Purple breast area left side










Purple breast area both sides









Purple breast area left side (also without coating)







Although we should never assume that a purple colour in the breast area indicates carcinoma of the breast, we should always take it seriously and treat it by invigorating Blood in the breast.

In case of carcinoma of the breast, there is a correlation between the purple colour of the breast area and the prognosis: the darker this area, the worse the prognosis.

If the breast area on the tongue is purple in women who have not been diagnosed with breast cancer, this sign may indicate a tendency towards the disease before any symptoms manifest; for this reason, observation of the chest/breast area in women is particularly relevant. When I do tongue diagnosis in a woman, I always check the chest/breast area carefully.

Apart from a purple colour, other possible changes in the chest area are teeth marks that are confined only to the chest area, red points, the absence of coating in the chest area and a swelling.

In women, teeth marks only in the chest area indicate usually a problem in the breast (possible carcinoma) occurring against a background of severe Qi deficiency.





Teethmarks breast area right side








Red points in the chest area indicate Toxic Heat in the lungs or breast.





Red points chest/breast area right side







In women, an absence of coating in the chest/breast area indicates a possible problem in the breast occurring against a background of Yin deficiency.





No coating breast area left side










No coating breast area left side










No coating breast area left side






In women, a swelling in the breast area indicates Phlegm in the breast (which may cause fibrocystic disease or also contribute to the development of carcinoma of the breast).




Swelling breast area both sides






The Women's Treasure remedy Clear the Moon resolves Phlegm and invigorates Blood in the breast.

Clear the Moon

Sunday, June 8, 2014

SPLEEN-YIN DEFICIENCY

When we study the pathology of the Internal Organs, for the Spleen, we generally emphasize Spleen-Qi and Spleen-Yang deficiency. This is understandable as these two patterns are indeed extremely common. By contrast, when it comes to the Stomach, we do mention Stomach-Yin deficiency. In fact, some people say that this is a well-known contradiction: the Stomach is a Yang organ but it suffers from Yin deficiency while the Spleen is a Yin organ but it suffers from Yang deficiency.

All this is true, but in this article, I want to discuss the aetiology, pathology, diagnosis and treatment of Spleen-Yin deficiency. 

Historical development
Although we nowadays emphasize Spleen-Yang deficiency, some of the old classics did often mention Spleen-Yin deficiency. For example, the Su Wen in chapter 3 says that the excessive use of bitter foods or herbs causes Spleen-Qi not to be “immersed”. Modern doctors interpret “Spleen-Qi not immersed” as Spleen-Yin deficiency. 

Doctor Wang Lun Ti (Ming dynasty) said that Stomach-Fire may injure Spleen-Yin.  Qin Huang Shi (1706) says in Zheng Yin Mai Zhi: “The Spleen may be deficient in Yang or Yin: in Spleen-Yin deficiency, there is deficiency of Spleen-Blood and Empty Heat arises.” 

Tang Zong Hai, author of “Xue Zheng Lun” bemoaned the fact that, since Li Dong Yuan (author of “Pi Wei Lun”), doctors paid attention to Spleen-Yang but not Spleen-Yin. 

Aetiology
The aetiology of Spleen-Yin deficiency is clearly dietary.  It is caused by irregular eating, i.e. eating in a hurry, eating standing up, eating while working at one’s computer, eating late at night, eating while discussing business, eating while in a state of worry, etc. 

However, besides the dietary causes, Spleen-Yin deficiency may also be caused by emotional stress related to worry and pensiveness and by excessive physical work that depletes the Spleen.

Clinical manifestations
The main clinical manifestations of Spleen deficiency are:

Poor appetite, distension after eating, dry stools, dry mouth and throat, dry lips, thin body, dull complexion without lustre, night-sweating, 5-palm heat (only if there is Empty Heat), bleeding (in small quantity), tongue without coating (red if there is Empty Heat), Fine pulse.1 

Please note that Empty Heat does derive from Yin deficiency but someone may have Yin deficiency for years before Empty Heat develops.  The tongue is in fact the best clinical sign to distinguish when Yin deficiency has given rise to Empty Heat: if the tongue lacks a coating but it is not red, there is Yin deficiency without Empty Heat.  If the tongue lacks a coating and it is red, then there is Yin deficiency and Empty Heat (Plates 1 and 2 and Fig. 1).

Plate 1 (no coating, normal colour)

Plate 2 (no coating, red colour)

Fig. 1. Progression of Yin deficiency and development of Empty Heat 


The Spleen controls yun hua, i.e. transportation and transformation of food essences.  Yun Hua is impaired not only when Spleen-Yang si deficient but also when Spleen-Yin is deficient, hence the lack of appetite. The Yin deficiency causes the loss of weight and therefore thin body. 

Spleen-Yin includes Blood and Ying and for this reason Spleen-Yin deficiency may cause bleeding such as in the stools, vomit or under the skin. 

Please note the sign of dry lips as this is quite a key sign of Spleen-Yin deficiency.

Chinese journals often include symptoms and signs of Empty Heat with Spleen-Yin deficiency and they say that this pattern cause the flaring up of the pathological Minister Fire. I tend to disagree with this view.  In chronic, long-standing cases, Spleen-Yin deficiency can indeed give rise to Empty Heat but, in very many cases, there is just Yin deficiency without Empty Heat (see Fig. 1 and Plates 1 and 2 above).

Pathology
Dr Hong Guang Huai makes an important differentiation between Stomach-Yin and Spleen-Yin deficiency. He says that in Stomach-Yin deficiency there is a deficiency of fluids while in Spleen-Yin deficiency there is a deficiency of Ying and Blood. They are both Yin deficiency as fluids, Ying and Blood are all part of Yin.2  

Diagnosis
Dr Mao Jiong divides the clinical manifestations of Spleen-Yin deficiency into three groups and this may help the diagnostic process.  The three groups are:

- Digestive symptoms: abdominal distension, poor appetite, dry stools.
- Yin deficiency symptoms (dryness): dry mouth and throat, dry lips.
- Lack of nourishment signs: dull complexion, thin body, dry skin. 

As mentioned above, dry lips is quite a key, distinctive sign of Spleen-Yin deficiency.  Another very distinctive sign are small transversal cracks on the sides of the tongue (Plates 3-4-5). 

Plate 3. Spleen-Yin deficiency cracks

Plate 4. Spleen-Yin deficiency cracks

Plate 5. Spleen-Yin deficiency cracks


Herbal Treatment
One must nourish Yin, strengthen the Spleen, nourish Ying and “lift” fluids. Doctor Wang Guang Jun summarizes the treatment in four words: sweet, sour, moisten, lift.

By “sweet” he means using herbs (and foods) with a sweet taste and the main herbs he advocates   are Huang Jing Rhizoma Polygonati, Tai Zi Shen Radix Pseudostellariae, Shan Yao Radix Dioscoreae oppositae and Bai Bian Dou Semen Dolichoris lablab

By “sour” he means herbs (or foods) with a sour taste because the sour taste keeps fluids in and it therefore nourishes Yin. Bai Shao Radix Paeoniae alba, Wu Mei Prunus Mume, Wu Wei Zi Fructus Schisandrae chinensis, Shan Zha Fructus Crataegi

By “moisten”, he means the use of herbs that are rich in fluids such as Lian Rou (lotus fruit).  By “lifting” he means the use of herbs that lift Qi such as Ge Gen Radix Puerariae and Sheng Ma Rhizoma Cimicifugae

Bearing these four principles in mind, Dr Wang recommends the following prescription to nourish Spleen-Yin. 

Huang Jing Rhizoma Polygonati
Tai Zi Shen Radix Pseudostellariae
Shan Yao Radix Dioscoreae oppositae 
Bai Bian Dou Semen Dolichoris lablab
Bai Shao Radix Paeoniae alba
Shan Zha Fructus Crataegi
Wu Mei Prunus Mume
Ge Gen Radix Puerariae 
Lian Zi Semen Nelumbinis nuciferae 
Da Zao Fructus Jujubae
Gan Cao Radix Glycyrrhizae

Dr Hong Guang Huai also recommends nourishing Yin and strengthening the Spleen and he says that two important herbs are Ren Shen Radix Ginseng and Tian Hua Fen Radix Trichosanthis. He recommends the following herbs for Stomach-Yin and Spleen-Yin:

Stomach-Yin: Mai Men Dong Tuber Ophiopogonis, Bei Sha Shen Radix Glehniae, Yu Zhu Rhizoma Polygonati odorati, Shi Hu Herba Dendrobii.

Spleen-Yin: Ren Shen Radix Ginseng, Tian Hua Fen Radix Trichosanthis, E Jiao Colla Corii Asini, Sheng Di Huang Radix Rehmanniae.

He also recommends herbs with a sweet and bland taste for Spleen-Yin such as Shan Yao Radix Dioscoreae oppositae, Lian Rou (lotus fruit), Geng Mi (rice), Mai Ya Fructus Hordei vulgaris germinatus, Tai Zi Shen Radix Pseudostellariae, Xi Yang Shen Radix Panacis quinquefolii, Bei Sha Shen Radix Glehniae littoralis, Ge Gen Radix Puerariae, He Ye Folium Nelumbinis

He recommends the following formulae for Spleen-Yin deficiency:
- Ren Shen Gu Ben Tang Ginseng Consolidating the Root Decoction.
- Zhi Gan Cao Tang Glycyrrhiza Decoction (without Gui Zhi Ramulus Cinnamomi and with the addition of Bai Shao Radix Paeoniae alba).
- Yu Quan Wan Jade Spring Pill

Acupuncture Treatment
The acupuncture treatment of Spleen-Yin deficiency is based on the following points: Ren-12 Zhongwan, Ren-4 Guanyuan, ST-36 Zusanli, SP-6 Sanyinjiao, LIV-13 Zhangmen. 

As Spleen-Yin deficiency very often occurs in conjunction with Stomach-Yin deficiency, I outline below the clinical manifestations and treatment of Stomach-Yin deficiency.

Stomach-Yin deficiency
No appetite or slight hunger but no desire to eat, constipation (dry stools), dull or slightly burning epigastric pain, dry mouth and throat especially in the afternoon with desire to drink in small sips, slight feeling of fullness after eating.
Tongue: without coating in the centre, or with rootless coating, normal body colour.
Pulse: Floating-Empty on the Right-Middle position (Plates 6-7-8-9). 
Plate 6. Stomach cracks.

Plate 7. Two patches without coating

Plate 8. Central Stomach crack

Plate 9. No coating in the centre. 


If there is Empty Heat, there will be some additional symptoms such as feeling of hunger, night-sweating, 5-palm heat, bleeding gums, feeling of heat in the evening, red tongue without coating in the centre, Floating-Empty pulse on the Right-Middle position and slightly Rapid. 

Points: Ren-12 Zhongwan, ST-36 Zusanli, SP-6 Sanyinjiao.

Herbal formulae (for Stomach-Yin)
Sha Shen Mai Dong Tang Glehnia-Ophiopogon Decoction.
Shen Ling Bai Zhu San Ginseng-Poria-Atractylodes Powder.
Yi Wei Tang Benefiting the Stomach Decoction.

Three Treasures for Stomach-Yin and Spleen-Yin
The Three Treasures remedies for Stomach- and Spleen-Yin deficiency are:

Central Mansion (variation of Shen Ling Bai Zhu San).
Jade Spring (variation of Sha Shen Mai Dong Tang).

Central Mansion is used for the beginning stages of Stomach- and Spleen-Yin deficiency: in such cases, the tongue will has some coating which is missing only in patches.

Jade Spring is used in full-blown Stomach- and Spleen-Yin deficiency: in such cases, the tongue has no coating at all.

Plates 10 and 11 illustrate the difference between Central Mansion and Jade Spring
Plate 10. Partially without coating. Central Mansion

Plate 11. Completely without coating. Jade Spring


END NOTES
1. The Symptoms and Treatment of Spleen-Yin deficiency by Wang Guang Jun in Journal of Traditional Chinese Medicine (Zhong Yi Za Zhi), Vol. 31, no. 2, 1990, p. 18.

2. Concerning the Differentiation between Stomach-Yin and Spleen-Yin Deficiency by Hong Guang Gui Huai in Journal of Traditional Chinese Medicine (Zhong Yi Za Zhi), Vol. 31, no. 7, 1990, p. 4.

3. Introduction to Research on Spleen-Yin Deficiency by Mao Jiong in Journal of Traditional Chinese Medicine (Zhong Yi Za Zhi), Vol. 32, no. 5, 1991, p. 50.

PRESCRIPTIONS
ZHI GAN CAO TANG
Glycyrrhiza Decoction
Zhi Gan Cao Radix Glycyrrhizae uralensis preparata 
Ren Shen Radix Ginseng 
Da Zao Fructus Jujubae 
Sheng Di Huang Radix Rehmanniae 
Mai Men Dong Radix Ophiopogonis 
E Jiao Colla Corii Asini 
Hu Ma Ren Semen Sesami indici
Sheng Jiang Rhizoma Zingiberis recens 
Gui Zhi Ramulus Cinnamomi cassiae 
Qing Jiu Rice wine 10 ml (added at the end)

REN SHEN GU BEN TANG
Ginseng Consolidating the Root Decoction 
Ren Shen Radix Ginseng
Shan Yao Radix Dioscoreae oppositae
Sheng Di Huang Radix Rehmanniae
Shu Di Huang Radix Rehmanniae preparata
Tian Men Dong Tuber Asparagis cohinchinensis
Mai Men Dong Tuber Ophiopogonis
Fu Ling Poria
Shan Zhu Yu Fructus Corni officinalis
Mu Dan Pi Cortex Moutan
Ze Xie Rhizoma Alismatis orientalis

YU QUAN TANG
Jade Spring Decoction
Huang Lian Radix Coptidis
Ge Gen Radix Puerariae
Tian Hua Fen Radix Trichosanthis
Zhi Mu Radix Anemarrhenae asphodeloidis
Mai Men Dong Tuber Ophiopogonis
Ren Shen Radix Ginseng
Wu Wei Zi Fructus Schisandrae
Sheng Di Huang Radix Rehmanniae
Lian Rou Lotus fruit
Wu Mei Prunus Mume
Dang Gui Radix Angelicae sinensis
Gan Cao Radix Glycyrrhizae uralensis
(plus human milk, cow’s milk, lotus juice, pear juice)

Sunday, May 18, 2014

ITCHING

Itching is a symptom that accompanies many diseases and patterns.  The main pathogenic factors that cause itching are:
Heat
External Wind
Wind in the skin
Dampness
Blood deficiency

For each pathogenic factor I will give the general acupuncture points for treatment.  Please note that these are only general points and other points depend on the disease and the part of the body affected. Please note that Baichongwo is an extra point located 1 cun above SP-10 Xuehai. Its name means "100 insects nest", a clear reference to its action on itching that feels as if insects were crawling under the skin. 

In the lists of points, I mention HE-7 Shenmen because, besides calming the Shen, it stops itching.

Heat
The itching caused by Heat manifests with red skin eruptions of the papular type.  It is seen in various diseases such as herpes.  In order to diagnose Heat as the cause of itching the tongue is important: it must be red with a yellow coating and possibly red points.

Acupuncture: LI-11 Quchi, SP-10 Xuehai, P-9 Zhongchong, LIV-2 Xingjian, HE-7 Shenmen.

Red papules
                                                                     

Red body with red points

External Wind
External Wind may cause itching such as itchy throat or itchy nose. 

Acupuncture: BL-12 Fengmen, TB-5 Waiguan, LU-7 Lieque, LI-4 Hegu. 

Wind the skin
By “Wind in the skin” I refer to a type of Wind that is neither internal nor external, but closer to the latter. Wind is a major pathogenic factor in skin diseases and it escapes a classification into internal or external.  

Wind in the skin is a major cause of itching in skin diseases.  It is characterized by being all over the body or moving from place to place. For example, in urticaria, the intense itching is caused by Wind in the skin.  Wind in the skin is also the cause of itching is certain types of eczema. We can diagnose Wind in the skin only when the itching involves the whole body or when it moves from place to place: if the itching is confined to one specific area, it is not Wind. 

Another characteristic of itching from Wind is that often there is nothing to be seen on the skin (although of course in urticaria there are bullae and in eczema papules).  Wind in the skin is the cause of itching in herpes zoster (but remember that this is also caused by Dampness).

Acupuncture: GB-31 Fengshi, TB-6 Zhigou, Baichongwo extra point, LIV-3 Taichong, HE-7 Shenmen.

Urticaria

Dampness
Dampness is a frequent cause of itching. Its main characteristic is that the itching is usually confined to one place.  For example, the itching from vaginitis or herpes is confined to the genitals.  The itching from Dampness manifests with vesicles or papules.  

When Dampness is combined with Heat, the itching is more intense as it is caused by the combined effect of both Dampness and Heat.  Damp-Heat is a major pathogenic factor in eczema: it is very important to treat the itching in eczema because scratching aggravates this disease significantly.  Indeed some of the pathology of eczema is caused by the scratching rather than the disease itself. Scratching causes skin erosion and it may facilitate the entry of bacteria that cause skin infections. 

Acupuncture: Ren-9 Shuifen, Ren-5 Shimen, BL-22 Sanjiaoshu, SP-9 Yinlingquan, Baichongwo, HE-7 Shenmen.

Herpes Zoster  (Damp-Heat)

Herpes simplex (Damp-Heat)
Genital herpes (Damp-Heat)

Blood deficiency
In Blood deficiency the itching is generalized, i.e not confined to a specific area. An important characteristic of itching from Blood deficiency is that is may occur without any skin lesions.  Itching from Blood deficiency is seen in chronic eczema (in which case of course there are skin lesions) and in psoriasis. 

The itching from Blood deficiency may also be accompanied by other changes in the skin such as dryness and desquamation: this is seen a lot in psoriasis. 

Acupuncture: LIV-8 Ququan, Ren-4 Guanyuan, ST-36 Zusanli, SP-6 Sanyinjiao, HE-7 Shenmen.

Desquamation
Erosion

Itching may also be classified according to Chinese categories of pathogenic factors as follows:
Du (Toxin)
Feng (Wind)
Jiu (Alcohol)
Re (Heat)

Du (Toxin)
The itching from Toxin manifests with erosion, papules or bullae and it appears suddenly.  Contact dermatitis is a good example of it.   

Acupuncture: BL-40 Weizhong, SP-10 Xuehai.

Bullae


Feng (Wind)
The itching from Wind is generalized.  It may be from external Wind or Wind in the skin as defined above.  It may also be from Internal Wind in which case it would manifest with desquamation. 

Acupuncture: GB-31 Fengshi, BL-12 Fengmen, GB-20 Fengchi, Du-16 Fengfu, TB-17 Yifeng.

Jiu (Alcohol)
This is the itching that affects people after drinking alcohol. This occurs in people who are not usual drinkers.  

Acupuncture: LIV-3 Taichong, SP-10 Xuehai, HE-7 Shenmen. 

Re (Heat)
As we have sen above, Heat is a common cause of itching and it may manifest with red bullae or papules. 

Acupuncture: LI-11 Quchi, SP-10 Xuehai, P-9 Zhongchong, LIV-2 Xingjian, HE-7 Shenmen.

THE PO AND ITCHING
The Po is the physical soul that resides in the Lungs. It is always contrasted with the Hun that resides in the Liver.  The Hun is Yang and survives after death; the Po is Yin and dies with the body.  

Zhang Jie Bin says: “The Po can move and do things and [when it is active] pain and itching can be felt”.  The Po is responsible for sensations and itching and is therefore closely related to the skin through which such sensations are experienced. For this reason, in itching, I also treat the Lungs with LU-7 Lieque. 

HERBS THAT EXPEL WIND IN SKIN DISEASES
Fang Feng Radix Saposhnikoviae
Jing Jie Herba Schizonepetae
Chan Tui Periostracum Cicadae
Cang Er Zi Fructus Xanthii
Bo He Herba Menthae haplocalycis
Niu Bang Zi Fructus Arctii

HERBS THAT RELIEVE ITCHING
Chan Tui Periostracum Cicadae
Ku Shen Radix Sophorae flavescentis
She Chuang Zi Fructus Cnidii
Xu Chang Qing Radix Cynanchi paniculati

Tuesday, April 1, 2014

DIAGNOSTIC DIFFERENTIATION OF DIGESTIVE SYMPTOMS

In this blog post, I will discuss the diagnostic differentiation between various digestive symptoms and specifically, a feeling of distension, fullness, oppression and stuffiness.

A feeling of  DISTENSION (zhang 胀) indicates stagnation of Qi.  This type of sensation will be seldom referred to as "distension" by Western patients: more often than not, patients will call it a feeling of “bloating”, "bursting", "being blown-up", etc.

A feeling of distension is both subjective and objective.  Subjectively, the patient feels bloated, and objectively, it can be seen and palpated.  On palpation it feels like an over-inflated balloon, it resists on palpation and “rebounds”.

A feeling of distension indicates Qi stagnation: it is the cardinal symptom of Qi stagnation which usually affects the Liver.  Remember, however, that it affects also other organs: in the context of digestive disorders, it affects the Stomach, Intestines and Spleen.

Note that Qi stagnation does not always derive from anger (whether repressed or not) but it frequently derives from worry or guilt.

The pulse reflects where the stagnation is centered. We can distinguish Liver-Qi stagnation, Stomach-Qi stagnation, Spleen-Qi stagnation and Qi stagnation in the Intestines.

- Liver-Qi stagnation: abdominal and/or epigastric bloating, related to emotional state. Pulse all Wiry or Wiry on left.


- Stomach-Qi stagnation: epigastric bloating, not much related to emotional state.  Alleviated by burping. Pulse Wiry on right Guan.


- Spleen-Qi stagnation: lower abdominal bloating, loose stools. Alleviated by passing gas and by rest. Pulse slightly Wiry on left and Weak on right.


- Intestines Qi stagnation: abdominal distension and pain,  borborygmi, constipation.  Alleviated by passing gas. Pulse Wiry on both Chi position.


Distension of epigastrium: Ren-10 Xiawan, Ren-12 Zhongwan, ST-21 Liangmen, ST-34 Liangqiu, ST-40 Fenglong, GB-34 Yanglingquan.

Distension of lower abdomen: ST-25 Tianshu, SP-15 Daheng, GB-34 Yanglingquan, Ren-6 Qihai.

A feeling of FULLNESS (man 满 ) indicates retention of food or Dampness. A feeling of fullness is different than a feeling of distension.  One  literally feels full and slightly nauseous.   It may affect the epigastriun or abdomen.

The feeling of fullness is subjective and objective.  Subjectively, the patient feels full and slightly nauseous.  It is felt objectively on palpation but not seen on observation. On palpation, the abdomen feels hard but not elastic as in the feeling of distension.

Epigastric fullness: ST-19 Burong, ST-21 Liangmen, Ren-10 Xiawan, SP-4 Gongsun/P-6 Neiguan (Chong Mai), ST-34 Liangqiu.

Abdominal fullness: ST-25 Tianshu, ST-27 Daju, SP-4 Gongsun/P-6 Neiguan (Chong Mai),  ST-37 Shangjuxu, ST-39 Xiajuxu.

A feeling of OPPRESSION (men 闷 ) denotes Phlegm or severe Qi stagnation.

A feeling of oppression is purely subjective and it is experienced mostly in the chest.  Some patients would describe it as a “weight” on the chest.  A feeling of oppression indicates Phlegm or also more severe stagnation of Qi.  The translation of this term cannot adequately convey the image evoked by its Chinese character: this depicts a heart constrained by a door and, besides the physical sensation, it also implies a certain mental anguish associated with this feeling.

In Western patients too, a feeling of oppression of the chest reflects emotional stress especially to do with sadness, grief, worry, shame and guilt.

Feeling of oppression of the chest: Ren-17 Shanzhong, P-6 Neiguan, LU-7 Lieque, ST-40 Fenglong.

A feeling of STUFFINESS (pi  痞) indicates Stomach-Qi deficiency or Stomach-Heat.  Contrary to the previous two sensations which can be felt objectively on palpation (e.g. a distended or full abdomen feels so on touch), the sensation of stuffiness is only subjective and the abdomen feels soft on touch.

The feeling of stuffiness is usually in the epigastrium.






DISTENSION
FULLNESS
OPPRESSION
STUFFINESS
Chinese
Zhang
Man 滿
Men 
Pi 
Subjective/objective
Both
Both
Subjective
Both
Objective on what
Palpation and observation
Palpation

Palpation
Symptom
Bloating
Feeling full, nausea
Feeling of weight
Mildly full
Pattern
Qi stagnation
Dampness
Phlegm
Deficiency and Stomach-Heat